Medical camp report 2012

Medical Camp Report 2012 - Bupsa &Bumburi, Nepal A medical camp was organized by Moving Mountain Trust Nepal, and Adventure Alternative Nepal, with support from Moving Mountain Trust (UK) at Bupsa and Bumburi VDC at district of Solukhumbu, Nepal. This medical camp was conducted during the month of Shrawan, 2069.

Team for this camp included a doctor (MBBS), a dentist (BDS), a dental assistant, volunteer medical students from Bristol University, UK, local health care personnel and managing team of Moving Mountain Trust Nepal and Adventure Alternative Nepal.

This camp was conducted for total duration of ten days with five days for each VDC.Hard work, dedication and enthusiasm of not only the appointed team but also the local people of Bupsa and Bumburi made it easier for us to set the camp with a good initiation and smooth continuation.

During our camp, we felt that people there were really suffering due to the lack of even a minor level of health care delivery which was reflected by the nature and spectrum of disease that they presented with in the camp.Complicated geography and lack of proper transportation facilities of those places is making people suffer even more in those conditions where they have to go to the higher center for medical care.

The motive of our camp was not only to treat the acute and treatable cases but also to diagnose, screen the chronic cases and counsell people about their helath condition and the measures they are suppose to take to avoid future health related disastrous outcome.We also tried our best to create health awareness in people there and emphasized the importance of health with the public and community as an a unit.

We have found a wide range of disease spectrum in Bupsa and Bumburi.But it was mainly dominated by dermatological, gastrointestinal ,musculoskeletal and gynaecological problem related patients. Skin related diseases mainly consisted of scabies,dermatitis,impetigo etc.

Acid peptic disorder/GERD, diarrhoea, dysentery, worm infestations were mainly encountered as GI related problems.

Various types of joint pain and myalgia were seen as predominant musculoskeletal problems.Menstrual cycle related problems, PID, UV prolapse and antenatal check up related patients were predominant among gynae/obs. Category.

Prevalence of hypertension was also noted in both VDC but Bupsa had relatively higher number of hypertensive patients. ENT related problems were also pretty much prevalent in both VDC’s.ASOM/CSOM and hearing problems were encountered much. Refractory error was seen as a potential opthalmological problem in both VDC’s.

Our camp also did some minor surgical procedures like various kinds of cysts excision, corn excision, implant removal etc.

Overall, we think that it was a very successful as a medical camp.It was because of the tremendous effort of all the team members and local people of Bupsa and Bumburi. Places like these definitely get benefited from medical camp like this but people there need much more sophisticated health care delivery system so that they get benefited in a stable and permanent basis.

Dr.Sunanda Paudel (MBBS), Nepal

Solukhumbu Surgical Report by Asef Zahed Intercalating medical student & Nepal Co-ordinator, University of Bristol The Solukhumbu free medical camp was a great success this year seeing over 1700 patients within the 10 day period. The cases seen were across a wide age-group demographic and several interesting cases were seen. However it is safe to say the three most common medical themes seen were osteoarthritis (mostly in middle age/elderly), infectious disease (particularly paediatric cases) and gynaecological problems. Respiratory and dermatological cases were also frequently seen.

Most cases were managed medically with drugs prescribed; it may be worth looking into the pharmacy inventory more carefully for next year’s clinic as certain drugs (especially infectionrelated such as metronidazole) were either running low or out of stock before the end of the camp.

In terms of surgical cases, around 15 operations were performed. This includes: lipoma removals, granuloma and foreign body removals, ganglion excisions, pilonidal sinus resection, tuberculous lesion excision, head injuries, cyst removal, hydrocele and several D & Cs. Though there were a variety of operations performed, I believe more could have been done if the some extra equipment was present such as an ultrasound scanner for the consideration of removing uterine leiyomyomas and also examining the state of the foetus for the pregnant women that were present. Also, it may be worthwhile investing in some basic ENT equipment such as otoscopes to improve our treatment possibilities for such patients and also for general examination, especially as a lot of the children did present with signs of otitis media. Endoscopy was suggested by a colleague but expertise on its use has to be also considered. In this respect, I would recommend expanding surgical services for next year, with the presence of new equipment and also an improvement in the treatments with regards

to increasing the sterile conditions (such as putting a sheet on the ceiling to prevent dust falling into the room). Of course, I don’t recommend upgrading to the level of general anaesthesia or any surgeries significantly larger than the one seen.

In terms of having a hospital built in the region, based on this camp and the group’s opinion at the time, I would certainly promote the idea. The reasons are because of the remoteness of the area and the fact that patients in the region are plentiful and cannot afford/reach any decent healthcare from their homes. Also, it is come to notice that a lot of these patients suffer from chronic disease and one doctor’s appointment or a few months worth of painkillers is no adequate in terms of long term individual care – a more permanent healthcare establishment is certainly needed to manage this group of patients. I do not recommend smaller projects as an alternative such as filtration/purification systems in the water tanks simply because they are wasteful and expensive to maintain but also because they only cater to a select group of patients suffering from infectious disease but not to the wider group of patients suffering from osteoarthritis or needing gynaecological attention.

From a personal account, this has been a fantastic experience all round. I learnt skills and knowledge that I will carry with me lifelong in my medical career and I have to graciously thank the doctors at the camp for their time and patience. As Nepal Trek coordinator for Bristol RAG 2012, I will certainly be strongly advertising and promoting this trip to medical students (or students interested in medicine) of all years as I believe they will have a fantastic opportunity to enforce their interest in medicine by immersing themselves in healthcare in a completely different backdrop to the one in the UK. Many thanks to all those involved and I hope that you continue to run these camps for years to come.

Statistics for Bupsa Medical Camp September 2012 Sex Male Female Total

175 260 435

Age 0-5 6-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

31 39 86 69 70 53 45 29 10 2 1

Village Bupsa Buksa Kharikhola Bumburi Salyan Jubing Rajbiraj Siraha Waku Juving Paiya Poiyan Sikly

147 23 83 5 2 1 1 1 18 72 1 4 22

Lakhim Kharte Balukhop Sotany Paiyan Kare Pangom Taubari Jaubaxi Sotang Chaurikharka Thamdanda Basa Illam

Diagnosis Infected rash Non-Infected Rash Dry Cough Eczema Allergic Conjuctivitis Verrucas Cataracts Well Contact Dermatitis Femoral Hernia URTI Epistaxis Abscess Postural hypotension Ear wax Infected foreign body Infected Acne Otitis Externa Myositis LRTI

4 17 9 1 3 2 4 3 1 2 1 3 3 1

20 35 27 9 8 1 9 24 1 1 40 2 2 4 2 1 1 4 1 15

SOL Ring worm Frostbite Urinary Tract Infection Non-specific abdominal pain Asthma Gastritis Fracture Dental abscess Costochondritis Tape worms Fungal skin infection Acute Musculoskeletal pain Chronic Musculoskeletal pain Hypertension Sensorineural Hearing loss Viral Gastroenteritis Infection - ?Source Dry Eyes Short/Long-sited Infective Conjunctivitis Pregnant Alcohol Excess Otitis Media Headache Dysmenorrhoea Menorrhagia Vaginal Candidiasis Angina Indigestion Diarrhoea - ?Cause Varicose veins Chronic Urinary Retention Constipation Diabetes Sexually Transmitted Infection Defecation syncope

1 1 1 9 15 11 71 1 2 2 8 8 16 121 25 1 14 7 12 17 9 5 8 3 11 4 2 1 2 7 11 0 1 3 2 3 1

Infected Wounds Renal Calculi Labyrinthitis Insect bite Non-infected wound Appendicitis Acne Hypotension Oral Ulcers Osgood Schlatters Vitiligo Chronic Sinusitis Salivary gland obstruction Tension Headache Upper GI Bleed Transient Ischaemic Attack

Treatment Antibacterial Eye drops Ampicillin/Cloxicillin Syrup Steroid Cream Ceterizine Eye drops Nil Paracetamol Syrup NSAID Tablets PPI Codiene/Tramadol NSAID Gel Salbutamol inhaler Oral Rehydration Sachet Amoxicillin Syrup Incision & Drainage Ceftriaxone IV Antibacterial Cream Anti-wax ear drops

8 1 1 1 8 1 2 2 1 1 1 1 1 2 2 1

9 8 23 1 24 1 42 99 60 22 91 19 27 8 2 1 11 2

Removal of foreign body Cloxicillin Tablets Antibacterial Ear drops Steroid Tablets NSAID IM Antacid Doxycycline Tablets Reassurance & Advice Antiseptic wash Antifungal cream Co-Trimoxazole Antihypertensives Antihistamine Tablets Antihelminthic Tablets Amoxicillin Tablets Cough Syrup Co-Trimoxazole Tablets Vaseline Multi-vitamins Antihelminthic Syrup Dressing Fluconazole Tablets Methanamic Acid Clotrimazole Pessary Laxatives Mebeverine Tablets Cefixime Tablets Azithromycin Tablets Metronidazole Antiemetic Tablets Antiemetic IM Paracetamol Tablets Cefotaxime IV/IM Metronidazole 500mg IV Antiemetic IV IV Fluids Antiseptic mouth wash

1 8 4 3 17 32 3 136 8 9 0 27 38 7 22 52 9 5 22 1 10 4 2 1 3 2 3 6 3 6 1 4 1 1 1 2 1

Plaster of paris cast Crepe Bandage Oral Cavity Ulcer Gel/Cream Azithromycin Syrup

1 1 2 3

Further Recommendations Advised eye check Return for review in 3 days Advised hospital review

32 9 33